Microenterprise in health care and health education

Over the last decade, development aid has increasingly used a more collaborative model, with donors and recipients both contributing ideas, methods and goals. Though many examples of collateral aid projects exist in agriculture, business administration and banking, few have found their way into health care and health education, a typically donor-dominated model. The following case report describes a collateral project in health care education. This case report analyzes data-inducing project proposals, personal interviews and project reports obtained through standard archival research methods. The setting for this joint project was the collaboration between international nongovernmental (NGO) aid foundations and the faculty of a major sub-Saharan African Medical School's Department of Anesthesia. The initial goal of this project was to improve record keeping for all anesthetic records, both in the operating theatres and outside. Analysis of the data was performed using ethnographic methods of constant comparative analysis. The purpose of the analysis was to critically evaluate both the goals and their results in the Department of Anesthesiology. The findings of this analysis suggested that results included not only quality assurance and improvement programs in the department but also advances in the use of critical incidents as teaching tools, hospital-wide drug and equipment utilization information and the initiation of an outreach program to district hospitals throughout the country for similar projects.     

Eco-cultural health,global health,and sustainability

Anthropogenic stress on the earth’s ecosystems has resulted in widespread prevalence of ecosystem distress syndrome, a quantifiable set of signs of ecosystem degradation. At the same time, the planet is witnessing rapid declines in global cultural diversity and in the vitality of the world’s cultures, which closely mirror, and are interrelated with, ecological degradation. As a consequence of this converging crisis of loss of ecosystem and cultural health, global health and sustainability are increasingly under threat. An eco-cultural health perspective based on understanding the linkages between human activities, ecological and cultural disruption, and public health is essential for addressing these threats and achieving global sustainability.     

Smoking and health

Cigarette smoking is the leading cause of preventable death and disease in Canada, accounting for some 30 000 deaths annually. This enormous health cost to Canadians has led the Canadian Medical Association (CMA) to promote initiatives regarding smoking prevention programs in schools, legislation to prevent smoking in government buildings and controls on smoking in private buildings, particularly places of work. The CMA recommends the prohibition of all forms of tobacco advertising/promotion in Canada, including advertising in conjunction with athletic events. The CMA also supports the taxation of tobacco products at a level to discourage their purchase, with revenue earmarked for health budgets, and the association is encouraging the federal government to develop alternative crop incentives for tobacco farmers. The norm of nonsmoking is a social attitude the CMA is working toward developing in all Canadians.     

Health and the city: physical health and mental health

In France, city size has very little bearing on the mortality rate as a function of age and life expectancy and it is in large cities that these indicators are the most favorable. No increase in maternal or infant mortality rates or deaths due to cancers has been observed in large cities. The lower mortality rate linked to respiratory and cardiovascular diseases in large urban areas contradicts the fears concerning the impact of air pollution. Deaths linked to lifestyle are less frequent in big cities, which could be due to social structures (socio-professional level: the proportion of white-collar workers and professionals is higher in bigger cities than in the suburbs or small cities). However, although the overall mortality rate is lower, it should be emphasized that there is in large cities a greater incidence of sexually transmitted diseases, AIDS and certain infectious diseases (because of social diversity and the fact that certain individuals seeking anonymity and marginality are drawn to large cities). In terms of mental health, the breakdown of family structures, instability, unemployment, the lack of parental authority and failing schools render adolescents vulnerable and hinder their social integration. When the proportion of adolescents at risk is high in a neighborhood, individual problems are amplified and social problems result. In order to restore mental and social health to these neighborhoods, ambitious strategies are necessary which take into account family and social factors as well as environmental ones. At the present time, when physical health is constantly improving, the most pressing problems are those related to lifestyle and mental health which depend for a large part on social factors.     

Sanitation and health

As one article in a four-part PLoS Medicine series on water and sanitation, David Trouba and colleagues discuss the importance of improved sanitation to health and the role that the health sector can play in its advocacy.     

Latino children's health and the family-community health promotion model

A majority of Latino children in the US live in poverty. However, unlike other poor children, Latino children do not seem to have a consistent association between poverty and poor health. Instead, many poor Latino children have unexpectedly good health outcomes. This has been labeled an epidemiologic paradox. This paper proposes a new model of health, the family-community health promotion model, to account for this paradox. The family-community health promotion model emphasizes the family-community milieu of the child, in contrast to traditional models of health. In addition, the family-community model expands the outcome measures from physical health to functional health status, and underscores the contribution of cultural factors to functional health outcomes. In this paper, we applied the family-community health promotion model to four health outcomes: low birthweight, infant mortality, chronic and acute illness, and perceived health status. The implications of this model for research and policy are discussed.